Understanding Albumin Solutions
Albumin solutions are derived from human plasma and are pasteurized to ensure safety, making them free of viral transmission risk. They are available in various concentrations, most commonly 5% and 25%. The choice of concentration depends on the patient's condition and the therapeutic goal.
- 5% Albumin (Iso-oncotic): This solution has an osmotic pressure similar to that of normal plasma. It is used primarily for volume expansion in hypovolemic patients.
- 25% Albumin (Hyper-oncotic): This solution has an osmotic pressure approximately five times higher than that of plasma. It is used to shift fluid from the interstitial space into the intravascular space, making it suitable for patients who require fluid removal from edematous tissues.
Indications and Patient Assessment
The decision to administer albumin is based on specific clinical indications and a thorough patient assessment. Key indications include:
- Hypovolemia/Shock: For fluid resuscitation when crystalloids have been ineffective.
- Hypoalbuminemia: To correct low serum albumin levels, particularly in cases of liver cirrhosis, severe burns, or infections.
- Large-Volume Paracentesis: To prevent post-paracentesis circulatory dysfunction after removing large amounts of ascitic fluid.
- Adult Respiratory Distress Syndrome (ARDS): Used in conjunction with diuretics to manage fluid overload.
- Severe Burns: Typically administered after the first 24 hours to address ongoing protein loss and fluid shifts.
Patient assessment prior to administration is crucial and involves:
- Vital Signs: Establishing baseline blood pressure, heart rate, and respiratory rate.
- Fluid Status: Evaluating for signs of dehydration or fluid overload.
- Electrolyte Levels: Especially sodium, as albumin solutions contain sodium.
- Allergy History: Checking for any known hypersensitivity to albumin products.
Step-by-Step Administration Protocol
Administering albumin involves a precise, systematic procedure to ensure patient safety and therapeutic efficacy.
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Verification and Preparation:
- Verify the physician's order, including the concentration, dose, and infusion rate.
- Inspect the albumin solution. It should be clear amber, and any discoloration, cloudiness, or particulate matter indicates it should not be used.
- Gather all necessary supplies: albumin bottle, vented IV administration set, infusion pump, and an appropriate venous access catheter.
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Infusion Setup:
- Perform hand hygiene and don gloves.
- Prime the IV administration set, ensuring all air is expelled from the line. Use a vented IV set for glass bottles, opening the vent after spiking the bottle to facilitate flow.
- Crucial Precaution: Never dilute albumin with sterile water, as this can cause hemolysis. For dilution, only use 0.9% sodium chloride or 5% dextrose.
- If infusing a large volume (over 1500 mL), warm the product to room temperature beforehand.
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Administration and Monitoring:
- Establish venous access, if not already in place.
- Connect the IV line to the patient and begin the infusion at the prescribed rate. An infusion pump should be used for accurate rate control, especially in patients with compromised cardiac function.
- Monitor the patient closely during the infusion for any adverse reactions, particularly during the initial phase.
- Regularly check vital signs and clinical hemodynamics, such as blood pressure, heart rate, and central venous pressure.
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Post-Infusion Care:
- Upon completion, the IV line should be flushed as per facility protocol.
- The unused portion of albumin must be discarded immediately, as it contains no preservatives.
- Documentation of the administration, including the batch number, is a required safety measure.
Special Patient Considerations
Infusion rates and precautions vary depending on the patient's underlying condition and fluid balance.
Adult vs. Pediatric Administration
| Consideration | Adult Patients | Pediatric Patients | Source |
|---|---|---|---|
| Dosing | Dose depends on indication, e.g., 25-50 g for hypoalbuminemia, with maximum daily dose of 2 g/kg. | Based on body weight, e.g., 0.5-1 g/kg for hypovolemia. Limited data exists, requiring careful assessment. | |
| Rate of Infusion | Typically 1-4 mL/min, but adjusted based on fluid status and indication. Higher rates for hypovolemic shock. | Slower rates are often necessary, especially in neonates. Rates should not exceed adult guidelines relative to body weight. | |
| Fluid Overload | Higher risk, especially with 25% albumin in normovolemic patients. Infuse slowly to prevent. | Risk of volume overload and hemodilution is a major concern. Monitor for signs closely. | |
| Dilution | 25% albumin can be diluted with 0.9% NaCl or D5W. 5% solution is usually administered undiluted. | Similar dilution guidelines apply, with extreme caution regarding total volume. |
Potential Adverse Effects and Management
While generally safe, albumin infusion can cause adverse effects. Monitoring for these and knowing how to respond is essential.
Potential adverse effects:
- Hypersensitivity: Allergic reactions, from mild flushing and hives to severe anaphylaxis. Stop infusion immediately and administer emergency treatment.
- Circulatory Overload: Symptoms include headache, dyspnea, jugular venous distention, and increased blood pressure. Slow or stop the infusion if these signs appear.
- Electrolyte Imbalance: Large volume infusions, particularly of 25% albumin, can cause electrolyte shifts. Monitor serum electrolytes and provide supplementation as needed.
- Hypotension: Infusing too rapidly can cause a drop in blood pressure. Slowing the rate often resolves this.
- Hemodilution: Administering large volumes can dilute red blood cells and clotting factors, potentially causing relative anemia or bleeding issues. Monitoring hematocrit and coagulation status is necessary.
Conclusion
Adherence to the proper protocol for administering albumin is crucial for ensuring patient safety and maximizing therapeutic benefit. This complex procedure requires careful patient assessment, precise preparation, vigilant monitoring, and awareness of potential adverse effects. The choice of albumin concentration and infusion rate is tailored to the individual patient's needs and clinical condition. Healthcare providers must follow established guidelines and prioritize continuous monitoring to detect and manage any complications promptly. Consistent and accurate documentation further reinforces safety and quality of care.
